Whitstable House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified a breach of regulation relating to the gaining of people’s consent. We found staff were not following best practice guidance when assessing people’s capacity and were placing restrictions on people, which were not appropriate. When people’s needs changed, their care and support was not always changed in line with their choices and preferences. The processes in place did not ensure people had the best outcomes and were supported to lead healthier lives.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People described how the physiotherapist had been involved with the assessment of their mobility needs. People told us the way they were transferred had changed which they did not always agree with or feel safe with staff using the equipment. Relatives told us they had not seen their relatives' care plans. However, some action had been taken when people’s needs had changed.

Staff told us, “When people join us, we ask them all about their preferences for care, their hobbies and interests, and if they can’t tell us very much, perhaps because they have dementia, we speak with their families and friends.” However, we we not assured staff made sure people's choices and preferences always recorded in people’s care plans and available for other staff.

The processes in place to make sure people’s needs had been assessed had not always been followed. People’s care plans did not always reflect their needs, choices and preferences. People's records did not always have relevant information about how people’s needs had been assessed, by whom and how the outcome had been reached. There were no effective processes in places to make sure records were accurate and contained all the relevant information to support people.

People told us they were not always asked about their choices and preferences. They were not involved in the development of their care plans. One person told us, “I have no voice in my care. They wrote the plan. I get 2 choices in my meals, but they aren’t very nice. My preferences are only known by some [carers].” Another person told us, "The staff ask you what meal you want but sometimes you don’t get what you ask for."

Staff told us how they got to know people’s preferences. One staff member told us, “We talk with people, try to get to know them, and ask them if they prefer a bath or a shower, for example, how they like to wear their clothes. We also talk with their families to see how they liked to dress in the past.” Nurses told us they kept up to date with their clinical skills but have liked to have had better clinical supervision.

The processes in place to complete people's care plans with them had not been followed by staff. People’s care plans were not always evidence based and there was not always information about how assessment tools had been used to develop the care plans. There was limited information about how people’s care needs were assessed, who was involved and how decisions were made.

Relatives did not feel that staff, teams and services always worked together well. Relatives told us they were asked to sign with a private GP who was not close by and not with the GP next to the surgery. They also expressed concern people were not always supported to attend appointments. A relative told us, "I do not understand why people are asked to sign up with a private GP some distance away instead of next door. (Relative) signed up with the surgery next door.”

Staff explained they worked with professionals who visited the service such as the physiotherapist, occupational therapist and wound nurse. But people’s voice had not always been promoted to make sure people’s preferences were considered.

We received feedback from other stakeholders, who told us, they were working with the service to rectify concerns they had identified around the quality of the service. They told us the provider had made some progress but some work had not been completed and if improvements would be sustained.

The processes were not effective as people were not listened to when describing their needs. All staff and professionals within the service did not always give the information people thought relevant when describing their needs to professionals outside the service.

Relatives did not always feel people were able to make choices about their health care provision. Relatives told us they were asked by the provider to sign with a private GP rather than one of their choosing. Although the provider told us after the inspection that people had a choice, relatives did not feel this way.

Staff told us people were referred to other health professionals when needed. They also told us people were supported to attend the podiatrist regularly.

The processes in place to refer people to health professionals were in place and nurses liaised with them. There was a requirement for any changes to people’s care to be recorded on their notes for staff to access on the electronic system. However, the information was not always recorded accurately and transferred to the person’s care plan.

People told us they had not been supported to maintain their skills and the outcome had been poor. One person told us, “I could use the Sara Stedy hoist previously, but the version of the Sara Stedy they use here is different to the one I used before. The physio here [Whitstable House] did a new assessment and said I couldn’t use a Stedy anymore as I wasn’t able to use it right first time. They didn’t involve me in the decision. Now they say I must be hoisted, and I’ve lost some of my independence." They also told us the sling for the hoist is left insitu and they find this stops them from completing their exercises, so they feel they are losing strength. People described how the carpet made it difficult to manoeuvre their wheelchair and the hoist.

Staff described how they supported people in a person centred way, but this was not the experienced people had of their care. Staff did not understand about how they affected outcomes for people, they could not explain how they improved people's outcomes and care experience.

There was no effective process in place to monitor the outcomes for people, they had not requested feedback from people to assess if people were happy with the outcome of their care. Care plans had not been monitored to check they included accurate information and there was no process to monitor outcomes.

People told us their choices were not always respected. One person said, "They put you to bed too early. They tell you to go to your room." Another person told us, “I do feel safe here, but I don’t want the bed rails. They say I must for health and safety reasons.” Other comments included, “They haven’t discussed my care with me or let me give my view.”

Staff described how they supported people to make day to day decisions. Comments from staff included, “We ask people how they like to be supported and what they want to do, where they want to sit, what they want to eat and drink.” And “We offer people choices about what they might want to wear, and we give them choices from 2 or 3 options if they can’t tell us, we go to their wardrobe and show them options.” However, this was not people's experience. We did not always see this during our assessment and people were not always offered choices or their preferences including at mealtimes.

Staff had not worked within the Mental Capacity Act 2005 (MCA), they had not followed best practice guidance. People were at risk of being restricted without following the required process. For example, one person received 1:1 supervision, which potentially restricted their ability to move around the service. An assessment was in place for the decision for the person to live at Whitstable House. It had been determined the person had capacity to make this decision, although there was no information how this decision had been reached and if they had been involved. There was no evidence the person had given consent to receive 1:1 care, which was potentially liberty depriving. Staff had not ensured people, or their legal representatives had completed consent records in relation to living at Whitstable House, having their photographs taken, or allowing healthcare professionals to review their documents. Consent records had been electronically signed by members of staff with no evidence people had been involved, including where there were no concerns regarding a person’s ability to consent. When people had been assessed as not having capacity to make a particular decision, the MCA stated a best interest decision should be made. Records were poorly completed with little information about how the decision was made including family input. Decisions had been made including the use of bedrails, but there was no evidence people had been included in these decisions. One person told us they did not want bedrails and there was no reference to this in the decision record. By not following best practice, staff had placed people at risk of being restricted and their decisions not being respected.